Healthcare Provider Details

I. General information

NPI: 1811967896
Provider Name (Legal Business Name): SHERRY C ROYSTER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 11/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 AIRPORT DR STE 102
ALEXANDER CITY AL
35010
US

IV. Provider business mailing address

1120 AIRPORT DR STE 102
ALEXANDER CITY AL
35010-3444
US

V. Phone/Fax

Practice location:
  • Phone: 256-234-3477
  • Fax: 256-712-2104
Mailing address:
  • Phone: 256-234-3477
  • Fax: 256-712-2104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number1-063579
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-063579
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: